Table Of ContentBahman Jabbari Editor
Botulinum Toxin
Treatment in
Clinical Medicine
A Disease-Oriented Approach
Botulinum Toxin Treatment in Clinical Medicine
Bahman Jabbari
Editor
Botulinum Toxin Treatment
in Clinical Medicine
A Disease-Oriented Approach
Editor
Bahman Jabbari, MD, FAAN
Emeritus Professor of Neurology
Yale University, New Haven
CT, USA
ISBN 978-3-319-56037-3 ISBN 978-3-319-56038-0 (eBook)
DOI 10.1007/978-3-319-56038-0
Library of Congress Control Number: 2017949684
© Springer International Publishing AG 2018
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I also like to dedicate this book to my wife
Dr. Fattaneh Tavassoli Jabbari who has done
a fair amount of editorial work in this book.
Preface
Over the past four decades, botulinum neurotoxins have made a major impact as
effective therapeutic agents for treatment of a variety of medical disorders in clini-
cal medicine. Their indications have now expanded from the field of movement
disorders to pain medicine and beyond. In the recent years it has become clear that
botulinum neurotoxins can effectively alleviate more than one symptom in a variety
of medical diseases ranging from spasticity, muscle spasm and sialorrhea in stroke
and spasticity, movement disorders and bladder dysfunction in multiple sclerosis. It
is, therefore, time to look beyond single symptom relief and explore specifically
how these agents can help a patient with various dysfunctions related to a single
disease.
This book provides information on the utility and efficacy of botulinum neuro-
toxins via a “Disease-Oriented Approach.” In the first chapter, Dr. Ornella Rossetto,
in a clear and concise language, describes the molecular structure and mechanism
of action of various available botulinum toxins. In Chaps. 2–14, the authors explain
the role of botulinum toxins in alleviating symptoms of different medical diseases
using an evidence-based approach. The use of ancillary techniques (Ultrasound and
EMG) to locate the muscles contributing to the symptoms (spasticity or involuntary
movement) is discussed by Drs. Katharine E. Alter and Barbara I. Karp in Chap. 15.
Chapter 16 of the book provides information on potentially upcoming indications
and what is on the horizon.
I am grateful to the help of several people who were instrumental in the devel-
opment and completion of this book, and to the authors of different chapters who
took time from their busy schedules and provided their chapters on time for pro-
duction. Fattaneh Tavassoli, M.D., provided invaluable editorial assistance.
Damoun Safarpour, M.D., and Tahereh Mousavi, M.D., have kindly provided the
drawings to illustrate the details of injection sites for several chapters. Carolyn
Spence and Michelle FengeHe from Springer provided the most useful guidance
and advice throughout the entire project. Foremost, I am much indebted to all
patients who, during almost four decades of my practice, supported and helped me
vii
viii Preface
learn how I can improve and obtain better results with botulinum toxin therapy in
clinical practice.
I hope this book will be of help to clinicians, other health providers as well as
researchers, ultimately providing better care to our patients.
July 24, 2017 Bahman Jabbari
Newport Coast, CA
Contents
Botulinum Toxins: Molecular Structures and Synaptic Physiology .............. 1
Ornella Rossetto
Botulinum Toxin Treatment of Primary Dystonia .......................................... 13
Avram Fraint and Cynthia Comella
Botulinum Toxin Treatment in Parkinson’s Disease and Atypical
Parkinsonian Disorders ..................................................................................... 23
Parul Jindal and Joseph Jankovic
Applications of Botulinum Toxin in the Urinary Tract .................................. 49
Saman Shafaat Talab, Hossein Sadeghi-Nejad and Patricia E. Gilhooly
The Role of Botulinum Toxin in the Gastrointestinal Tract ........................... 67
Kaveh Sharzehi and Ron Schey
Botulinum Toxin for Treatment of Spasticity in Cerebral Palsy ................... 81
Kat Kolaski and L. Andrew Koman
Botulinum Toxin Treatment in Multiple Sclerosis ..........................................109
Yasaman Safarpour and Bahman Jabbari
Clinical Uses of the Botulinum Toxin and Ophthalmology ............................131
Jennifer A. Galvin
Botulinum Toxin Treatment of Migraine and Other Headaches ...................145
Sara M. Schaefer and Bahman Jabbari
Botulinum Toxin Treatment of Neuropathic Pain ...........................................167
Shivam Om Mittal and Bahman Jabbari
The Role of Botulinum Toxins in Treatment of Brain
and Spinal Cord Injury Symptoms ..................................................................193
Taraneh Hashemi-Zonouz and Bahman Jabbari
ix
x Contents
Botulinum Toxin Treatment in Cerebrovascular Disease ...............................213
Iman Moeini-Naghani and Bahman Jabbari
Clinical Uses of Botulinum Toxin in the Skin ..................................................231
James Yen Wang
The Role of Botulinum Toxins in Treatment of Cancer-Related Issues:
Post-radiation and Post-surgical Pain and Radiation-Induced Damage
to the Salivary Glands........................................................................................247
Delaram Safarpour and Bahman Jabbari
Ultrasound, Electromyography, Electrical Stimulation;
Techniques Aiding More Effective Botulinum Toxin Therapy ......................259
Katharine E. Alter and Barbara I. Karp
Botulinum Toxin Therapy: Future Perspectives .............................................293
Bahman Jabbari
Index ....................................................................................................................303
Botulinum Toxins: Molecular Structures
and Synaptic Physiology
Ornella Rossetto
Introduction
Botulinum neurotoxin (BoNT) was identified as the sole cause of botulism over a
century ago, after the discovery of the anaerobic and spore-forming bacteria of the
genus Clostridium [1]. Botulinum neurotoxins are produced by different C. botu-
linum strains, which belong to four phylogenetically distinct groups, and by C.
butyricum and C. barati and are historically classified into seven different sero-
types (BoNT/A to /G) based on their immunological properties. Among the seven
BoNT serotypes, types A, B, E, and F are associated with botulism in both humans
and animals, whereas BoNT/C and /D primarily cause disease in domestic ani-
mals. BoNT/G-producing organisms have been isolated from soil but never
reported as the cause of botulism. Recently, thanks to the development of next-
generation sequencing, many toxin variants named subtypes have been identified
within each serotype (distinguished using an alpha-numeric code BoNT/A1, /A2,
etc.) and much more are expected to be reported soon [2, 3]. BoNTs bind with
high affinity to peripheral cholinergic nerve terminals and enter into their cytosol
where they cleave SNARE proteins thus blocking the release of neurotransmitters.
The high potency and neurospecificity, the very limited diffusion when locally
injected, and the reversibility of action have rendered BoNT/A1 the safest and
most efficacious therapeutic for the treatment of a variety of human pathological
conditions characterized by hyperfunction of selected nerve terminals. Their clini-
cal use has been continuously expanding since its introduction in the 1970s,
O. Rossetto (*)
Dipartimento di Scienze Biomediche, Università di Padova,
Viale G. Colombo 3, 35121 Padova, Italy
e-mail: [email protected]
© Springer International Publishing AG 2018 1
B. Jabbari (ed.), Botulinum Toxin Treatment in Clinical Medicine,
DOI 10.1007/978-3-319-56038-0_1
